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General NPI Number Information
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NPI Number | 1205342177
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Entity Type | Organization
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Legal Business Name | PRIMERO SPINE AND JOINT LLC
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 13241 BARTRAM PARK BLVD UNIT 2501
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5218
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Country | US
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Telephone | 561-843-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 W WINDY WILLOW DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-5098
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIEL BUSQUETS
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Credential | DC
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Telephone | 561-843-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH12201
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License Number State | FL
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